I thought I had seen it all, but this is the terrifying episode in my emergency room that left me shocked and nauseous. There is a dark new crisis in our hospitals that we are all missing. We must act before it is too late: PROF. ROB GALLOWAY

I just finished a night shift in the emergency room – and am still writing this feeling nauseous about what I saw.

Not because the night was filled with cardiac arrests, dying patients or terrified families. After 25 years in emergency medicine, I’ve seen it all before and I’ve learned to accept it as part of my job.

But I am left shocked and sickened as I saw staff punched, kicked and spat on in the face in one of the most frightening and brutal attacks I have ever seen by a patient.

And it happened in a hallway full of patients who were shocked by what they saw; many lay on carts and could not simply distance themselves from the violence, and were afraid that they too would be injured.

Even worse, the patient who attacked our staff should never have been in our department in the first place; he was only there because he was waiting for a mental health bed.

Hospitals should be safe places, not places where frightened patients watch as staff are attacked and put themselves in harm’s way.

Yet emergency room violence occurs in hospitals across the country. It is a national crisis that needs to be addressed urgently – but I fear it will take the terrible death of a medical professional or a patient for those in power to wake up to this.

And this may happen sooner or later unless something changes.

Violence in the emergency room is not new. But the violence now feels worse and the risks greater than ever before.

There are two reasons for this: a lack of mental health beds; and because the violence from drugged and drunk patients, which used to be handled in police stations, now seems to happen much more often in emergency departments.

The true scale of the problem remains hidden – because although hospitals record large numbers of cases of verbal abuse, threats and violence against staff every year, many staff do not formally report what happens to them.

But take a look at the latest annual anonymous NHS Staff Survey, published in March, for a true picture of the shocking state we find ourselves in.

More than 766,000 staff responded, with almost one in seven reporting they had experienced physical violence by a patient or member of the public in the past year, the highest rate in three years.

One difference is what happens to people who are drunk on drugs or alcohol, but also exhibit threatening behavior.

Of course, if they have a medical problem, they should be in the emergency room. But that is very different from what happens so often, where the police have to take someone to the emergency room ‘for observation’ simply because he is drunk, violent and aggressive.

In the past, many detainees were assessed at police stations by doctors, usually general practitioners with specialist training. They could treat minor injuries, decide whether someone could safely remain in custody, or send them to hospital, accompanied by police, if they really needed it. That decision struck a balance between the needs of the individual and the safety of NHS staff and the general public.

That system has changed. There are fewer GPs employed to do this work – experienced doctors cost more than the other doctors who are increasingly being used.

As a result, custody assessments are now often carried out by less experienced staff, including nurses, who may not have the same training, experience or authority to make complex judgments about whether a detainee can remain safely in custody.

Understandably, they are cautious and send them to the hospital. Someone who is drunk and violent and has only a minor wound may have previously been treated or monitored in custody. Now there is a greater chance that they will end up in our emergency department.

I understand why. No one wants anyone to get sick in a cell.

But if we only look at the risk to one individual and ignore the risk to everyone else, we have not made the system more secure. We simply moved the danger to the emergency room.

The second issue impacting the safety of our emergency departments is the increasingly apparent inadequacy of mental health care.

Patients in serious mental health crisis stay in emergency rooms for days due to a lack of mental health assessment suites or hospital beds. They arrive at an already overcrowded ward, often in distress, drunk or agitated, and can wait for hours for a specialist mental health assessment.

This is not an attack on people with mental illness or on the critical importance of caring for them.

In most circumstances, very few of these patients are violent. But they need a quiet, specialist environment. The emergency room is often a terrible place for them: overstimulating, undignified and completely unsuitable for the care that many of them need.

But being compassionate cannot mean pretending that there is no risk of violence.

Three months ago, an A&E doctor in his 50s was stabbed several times at Hillingdon Hospital in west London. A 27-year-old man has since been charged with causing grievous bodily harm with intent, possessing an offensive weapon and stealing knives.

And in January last year, a nurse at the Royal Oldham Hospital was stabbed repeatedly with scissors by a patient admitted for a mental health assessment. She suffered life-threatening injuries, had to undergo emergency surgery and spent the night in intensive care.

Every doctor and nurse who read that story will have had the same thought: that could have been me, or one of my colleagues – or one of my patients.

These are not just ‘incidents’ that have to be assessed by a hospital committee a few weeks later. They change the way employees feel when they come to work. They also change how safe patients feel as they wait to be seen.

After the episode I described at the beginning of this article, the hallway became quiet. Patients, some of them elderly and frail, lay on carts and stared at us in visible shock. You could see the fear on their faces – one violent patient had traumatized an entire hallway.

But I’m lucky where I work. We have an excellent 24 hour security team and the violent patient was removed quickly.

We also bring in metal detectors that we can use on patients upon arrival to alert security staff if someone is carrying anything suspicious.

Without it I would feel very exposed. I’m a six-foot-tall wimp without this kind of security behind me. Even when they are there, I still feel scared sometimes, and I was on this last shift – but at least I know there were people who understand the risks and know how to intervene and protect me.

Many hospitals employ dedicated emergency security teams, but the level of 24-hour coverage, training and immediate availability varies considerably from country to country.

That’s why I’m asking our new Health Minister, Yvette Cooper, to make the changes we need.

All emergency departments must have visible security staff 24 hours a day: we need secure entrances with metal detectors to ensure that people cannot simply walk into the department, let alone walk in with a weapon.

We need consultation rooms with two exits so no one can be cornered, easily accessible panic alarms and furniture that cannot be used as a weapon.

To reduce the number of violent people in emergency rooms, we need to bring doctors back into police custody.

We also need good mental health facilities, separate from emergency departments, where people in crisis can be assessed and treated in an environment designed for their needs.

And this has been said before: we need enough mental health beds. England had 23,447 NHS mental health beds in 2010-2011. By 2024-2025 that had fallen to just under 18,000.

When all these failures come together, the emergency room becomes a violent and frightening place, not only for the staff, but also for the patients who come to us expecting to be safe.

@drrobgalloway